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1、1Acute progress of Wegeners granulomatosis clinic experience and review of the literatureJournal write Network: author: Jia Li, Xia Chu Tak Sun ridge peak Liu Jing Lei Huiping Abstract Objective To analyze a case involving the skin, oral mucosa, eye, ear, kidney, lung system rapidly progressive clin
2、ical manifestations of WG granulomatosis, clinical early diagnosis, early treatment based on Methods A retrospective analysis of patients with clinical, laboratory examination and treatment, diagnosis of WG granulomatous pulmonary bleeding to death of the patients clinical data and results of this c
3、ase is characterized by: 1. older women .2. involving the skin, oral mucosa, eye, ear, kidney, lung based clinical performance of the WG granuloma, a total duration of more than a month. by the Department of Neurology Treatment of four days invalid transferred to the Department of Nephrology. progre
4、ssion abrupt death after 1 week of treatment due to hemoptysis. conclusion WG granuloma progress abrupt, the diversity of clinical 2manifestations, misdiagnosed, mistreated. prompted ANCA-associated vascular inflammation, especially the elderly, combined eye, ear, kidney, lung, oral cavity, multi-sy
5、stem disease, should be vigilant, as early as diagnosis, patients with hemoptysis by hormones and cyclophosphamide pulse therapy and hemodialysis effect was not obvious who should be Early plasma exchange to remove the potential pathological ANCA antibodies in the body through the acute risk period
6、may reduce the risk of death. Keywords: WG granuloma clinical manifestations of early plasmapheresis A case Female patient, 62 years old. Chief complaint: dizziness January, aggravated with tinnitus, progressive hearing loss, the close relationship between .1 20 days in patients with no obvious ince
7、ntive to dizziness, showed persistent, balance disorders in standing and walking, shaking, dizziness and postural changes ignore the matter rotation, no diplopia, no palpitations, chest tightness, sweating, untreated .20 days ago in patients with colds, the measured body temperature of 38.0 C 3night
8、 sleep binaural high-pitched ringing in the ears, decreased hearing in the course of the face and trunk feel abnormalities, chewing, drinking and swallowing difficulties, not accompanied by dizziness, unconsciousness, no obvious cough, expectoration, had received treatment in the Gaoling hospital, r
9、eadme chest radiograph prompted bronchopneumonia, give symptomatic treatment of dizziness and deafness no improvement. then submitted vertigo syndrome admitted to the Department of Neurology. Admission examination: body temperature of 37 C, the spirit is poor, bilateral conjunctival hyperemia, decre
10、ased visual acuity, the left buccal mucosa can be seen 5-6 months size ranging from gray verrucous nodules, lower limbs scattered in size, ranging from skin bleeding points, pairs of lower extremity pitting edema. Mind clear, fluent speech, higher cortical function was normal, eyes visible to the ga
11、ze of the right side of the horizontal nystagmus crude measure hearing loss, the Weber experiment center, Rinne, experimental, Schwabach experiment can not be completed. Auxiliary examination: blood: WBC 10.41 10E9 / L neutrophils percentage 92.10%, 4hemoglobin 77g / L, platelets 120 10E9 / L, urine
12、: urine protein 2 +, occult blood 3 +, microscope erythrocyte 4-5/HP, July 29 renal : / L, and urea 12.15mmol the creatinine 231.8umol / L; August 1, 2009 review of renal function: urea 22.6mmol / L, the creatinine 491umol / L; renal ultrasound: normal renal size, consider the image light diffuse le
13、sions and right kidney degree of separation, otoscope: Bilateral periosteal tension Ministry of visible perforation, the consultation of ear, nose Branch: see tension Ministry of bilateral periosteal playing perforation (the old, audiometry said: conduction deafness of the left ear, lung CT: scatter
14、ed pairs lung plaques and nodules. C-of ANCA-positive PR3-positive 129.6RU/mL; ESR: 109mg / L, anti-GBM antibody-negative, the main treatment options: diagnostic considerations and rapidly progressive glomerulonephritis III Wegener granuloma. Treatment given methylprednisolone, cyclophosphamide puls
15、e therapy, oral prednisone 40mg / day, while every other day hemodialysis treatment patients during treatment in patients with nausea, 5vomiting, vomit occult blood positive, given antibiotics to protect the gastric mucosa .1 weeks after treatment, patients with persistent hemoptysis, blood to blood
16、 clotting enzyme hemostasis, oxygen therapy, hemoptysis symptoms do not improve, consider giving plasma exchange. given consent by the patients family members prepare the plasma in the preparation of the line plasma one hour before the replacement, in patients with sudden difficulty in breathing, moist rale was significantly increased oxygen saturation decreased to 55%, after she died. Share in the free paper download center http:/discussion
